Estimating population prevalence of posttraumatic stress disorder: An example using the PTSD checklist

Abstract

The PTSD Checklist (PCL) is among the most widely used self-report instruments for assessing PTSD. To determine PCL's performance on a population level, the authors combined data from published studies that compared the PCL with structured diagnostic interviews. Weighted average sensitivities and specificities were calculated for cutoff categories most often reported in the literature. Weighted average sensitivity decreased from .85 to .39 and specificity increased from .73 to .97 for cutoffs ranging from 30 to 60. The PCL's ability to accurately estimate PTSD prevalence varied as a function of cutoff and true PTSD prevalence. In populations with a true PTSD prevalence of 15% or less, cutoff values below 44 will substantially overestimate PTSD prevalence. Uncalibrated use of the PCL for prevalence estimation may lead to large errors.

Preliminary analysis of posttraumatic stress disorder screening within specialty clinic setting for OIF/OEF veterans seeking care for neck or back pain

“…Terhakopian et al stressed that determining the ideal PCL cutoff score should be a function of the purpose of the measure (clinical screening tool vs estimation of population prevalence) and the population prevalence of PTSD [63]. Lower cutoff scores may also be of value in detecting PTSD on screening instruments among recent military returnees who may have a stigma against reporting PTSD symptoms and other psychological problems [46].…”

Risk factors and posttraumatic stress disorder: are they especially predictive following exposure to less severe stressors?

“…[25] One of the most widely used self-report measures of PTSD, [26] the PCL-C contains 17 items that constitute the symptomatic criteria for PTSD. Subjects rate each item on a five-point scale ranging from one (Not at all) to five (Extremely) to indicate how seriously the symptom has bothered them during the past month.…”

Effectiveness of battlefield-ethics training during combat deployment: a programme assessment

“…5,6 The PTSD checklist-military (PCL-M) 17 and the patient health questionnaire (PHQ) 9, which have been validated and widely used in military and veteran populations, were used to assess for PTSD and depression in the soldiers who completed the survey after training. [18][19][20][21] Additionally, nine statements about soldiers' attitudes towards the battlefi eld-ethics chain-teaching programme were included in the post-training survey.…”

“…The PCL-M has been validated and widely used in military populations, and a score of 50 or greater has been deemed optimum for the identifi cation of PTSD in population-level research. 18,19 The PHQ 9 is a nine item, self-administered version of the depression module of the primary care evaluation of mental disorders. 20 This test assesses the nine diagnostic criteria for depression on a scale 0 (not at all) to 3 (nearly every day) and is used widely in the military.…”